Obamacare form: fewer pages, more fine print?

Revised health application is shorter — or at least seems to be

By

JenWieczner

The Obama Administration announced Tuesday that it had shortened the much maligned application form for the health insurance exchanges. But critics point out that to cut the original 21-page paper application to three pages for individuals and seven pages for families, the administration used a few subtle tricks straight out of the college student playbook.

An earlier draft of the paper application, released in January, was widely criticized and compared with IRS tax forms for its length and complexity —along with the 61-page instruction manual for applying for coverage online.

The new application for health coverage under the Affordable Care Act’s insurance exchanges, opening Oct. 1, “has been simplified and significantly shortened,” the Centers for Medicare & Medicaid Services said in a press release Tuesday. Based on feedback from consumer groups, the new forms are “easier to use and significantly shorter than industry standards,” CMS acting administrator Marilyn Tavenner said in a statement.

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But anyone who’s ever had to write a term paper knows that sometimes the easiest way to deliver the required number of pages is to simply adjust the font size, margins and line spacing—and that’s basically what the administration did, critics say.

“This appears to be more cosmetic and not substantive changes,” says Sage Eastman, a spokesman for Republican members of the House Ways and Means Committee.

The committee used quotation marks to describe the forms as “shortened” or “new,” to illustrate their doubts that substantial revisions were made. Susan Kleimann, vice chairperson for the nonpartisan Center for Plain Language, which advocates for document clarity, says the authors of the application crammed a lot of important information in fine print at the end, as though they “didn’t want to go to another piece of paper,’” she says. “Did they really cut it from 21 pages to 7? No, not exactly.”

Instead of significantly revising the old application, CMS split it into individual and family versions (three forms total), and omitted page numbers from the instructions and other sections so the document appears shorter. For example, while pages 15 to 21 in the former application featured questions on everything from employer health coverage to status as an American Indian, the abbreviated version for families relegates those questions to four pages of appendixes at the back — bringing the real page count to 12 instead of seven. The three-page individual application form actually totals five, including appendixes and instructions.

Reuters

Supporters of the Affordable Healthcare Act gather in front of the Supreme Court before the court's announcement of the legality of the law on June 28, 2012.

CMS also managed to lop off eight full pages with a single change. While the original application devoted 12 pages to letting up to six people to apply on the same form, the condensed version just leaves room for you and one other dependent—instructing applicants to “make a copy” of those pages if more than two people are applying for coverage. Based on feedback from consumer groups, the new forms are “easier to use and significantly shorter than industry standards,” CMS acting administrator Marilyn Tavenner said in a statement.

“Going from one form to three forms with multiple appendixes is not simplification,” Eastman says. “Only a Washington bureaucracy would pat itself on the back for that kind of work.”

To be sure, some consumer advocates defended the editing maneuvers, saying that simplifying the form makes people more likely to complete it, increasing access to health care. “Just shortening it makes them less likely to be deterred,” says Kleimann, who supports the Affordable Care Act. And because the unnumbered pages at the end of the application are optional, she wouldn’t have counted them either, Kleimann adds: “I think it’s probably a very smart decision to get more people to pick this up.”

Officials worry that if the application seems so daunting that many Americans opt out, key health reform provisions will unravel and insurance premiums will go up across the board. “The reality remains that Americans will still face a long, confusing process,” Eastman says.

A CMS spokesman, however, says the agency “consolidated” the form by redacting some examples of income sources requiring disclosure, an option to get text message alerts and a question about what language the applicant preferred besides English. While CMS originally estimated that it would take someone 20 to 45 minutes to fill out the paper form, testing shows that the abridged individual application will only take about nine, the spokesman says: “Now people aren’t presented with a wide range of questions that don’t apply to them.”

Still, simply making the health exchange application seem shorter could actually help them get the benefits they deserve. The original 21-page form was “just intimidating to even hear that you would have to sit down and fill that out,” says Laura Adams, senior insurance analyst for InsuranceQuotes.com, which is developing a tool people can use to figure out if they qualify for health care through the exchanges.

And don’t underestimate the power of less paperwork, says Kleimann: “This doesn’t look like it’s that hard. It looks doable.”

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